title: Tumor recurrence is independent of pancreatic fistula in patients after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.
abstract: BACKGROUND
  Recurrence of pancreatic adenocarcinoma after pancreaticoduodenectomy (PD) can be increased in patients with pancreatic fistula (PF). The purpose of our study was to determine if a relationship exists between PF and tumor recurrence (both peritoneal and local) in patients after PD for pancreatic ductal adenocarcinoma.
  
  
  METHODS
  A single-institution, retrospective analysis of 221 patients who underwent PD from January 2001 to December 2009 was conducted. Electronic charts and medical records were queried for tumor characteristics, recurrence, and complications. Presence and grading of PF was determined using the criteria of the International Study Group on Pancreatic Fistula. Data were analyzed using chi-square and Kaplan-Meier survival statistics.
  
  
  RESULTS
  There were 114 male and 107 female patients. Mean age was 66 years (range 35 to 91 years). The vast majority (84%) of patients had stage II disease; 143 (65%) had positive lymph nodes (median 2 positive nodes; range 1 to 17 positive nodes). Pancreatic fistula developed in 23 patients (grade A, n = 9; grade B, n = 13; grade C, n = 1; 10.2%). Peritoneal recurrence was noted in 20 patients (9%). Of the 23 patients with PF, peritoneal recurrence developed in 3 (13%). Of the 198 patients without PF, peritoneal recurrence developed in 17 (10%). Local recurrence occurred in 47 patients (21%), 5 (2%) in patients with PF and 42 (21%) in those without PF (p = NS). In Kaplan-Meier survival analysis, there was no significant difference in recurrence-free survival (p = 0.4) and overall survival (p = 0.3) for those with PF vs those without PF.
  
  
  CONCLUSIONS
  Patients with PF after PD were not found to have a significant increase in local or peritoneal recurrence. Therefore, in this analysis, postoperative PF does not appear to serve as an adverse prognostic marker.
authors.affiliation: Department of Surgery and the Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
authors.forename: M Mura
authors.initials: MM
authors.lastname: Assifi
authors.forename: Sarah
authors.initials: S
authors.lastname: Zhang
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Leiby
authors.forename: Edward C
authors.initials: EC
authors.lastname: Pequignot
authors.forename: Brent
authors.initials: B
authors.lastname: Xia
authors.forename: Ernest
authors.initials: E
authors.lastname: Rosato
authors.forename: Harish
authors.initials: H
authors.lastname: Lavu
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Kennedy
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.forename: Adam C
authors.initials: AC
authors.lastname: Berger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000453:epidemiology / Q000556:secondary / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000473:pathology; D010185:Pancreatic Fistula / Q000453:epidemiology* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010534:Peritoneal Neoplasms / Q000453:epidemiology* / Q000556:secondary; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: HR; OS; PD; PF; PJ; RFS; hazard ratio; overall survival; pancreatic fistula; pancreaticoduodenectomy; pancreaticojejunostomy; recurrence-free survival